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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610305
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:19:44 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/22/2023 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20230322162006
FACILITY NAME:BRIGHTSTAR SENIOR CARE,INCFACILITY NUMBER:
197610305
ADMINISTRATOR:ALLAHDADI, AYEDEHFACILITY TYPE:
740
ADDRESS:10455 GAYNOR AVETELEPHONE:
(818) 517-0544
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 6DATE:
07/20/2023
UNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Ayedeh AllahdadiTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is denying residents visitation
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Evilin Rios and Michael Cava conducted a subsequent complaint visit to the facility to obtain additional information pertaining to the above allegation. LPAs met with the administrator, Ayedeh Allahdadi, and advised her of the visit. Today's investigation consisted of record review, which was conducted at apprximately 1:30pm to 2:00pm.

Based on the information obtained, the investigation to remain Unsubstantiated at this time. The administrator was advised and a copy of this report given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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